Bladder and ureteral injuries are uncommon in trauma patients but are associated with
increased morbidity and mortality. Patients presenting with such injuries may undergo
either open surgical repair or laparoscopic repair. We aimed to compare outcomes of
open surgical approach and laparoscopy in trauma patients with isolated bladder and
ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes.
We performed a 2017 review of American College of Surgeons Trauma Quality Improvement
Program and identified trauma patients with bladder and ureteral injury who underwent
open surgical repair or laparoscopy. A 1:1 propensity score matching was performed
adjusting for demographics, emergency department vitals (systolic blood pressure,
heart rate, Glasgow Coma Scale), mechanism of injury, Injury Severity Score, each
body region Abbreviated Injury Scale score, and transfusion units. Outcomes were rates
of in-hospital major complications and mortality.
Of the 1,004,440 trauma patients, 384 patients (open: 192 and laparoscopy: 192) were
matched and included. The mean age was 36 ± 15 y, Injury Severity Score was 27 [27-48],
77% were males, and 56% of patients had a blunt mechanism of injury, and 44% had penetrating
injuries. Overall mortality was 7.3%. On univariate analysis, mortality was lower
in the open group as compared to the laparoscopy group (10.4% versus 4.2%, P = 0.019) and survivor-only hospital length of stay was longer in the open group (8
[8-9] versus 7 [5-11], P = 0.008). There was no difference in overall major complications (23% versus 21%, P = 0.621). On multivariate analysis, open surgical repair was independently associated
with lower odds of mortality (adjusted odds ratio: 0.405, 95% confidence interval:
[0.17-0.95], P-value = 0.038)
In our analysis open surgical repair of bladder and ureteral injuries was associated
with lower mortality with other outcomes being similar when compared to laparoscopy.
Laparoscopic surgical repair may not have an advantage over the open surgical repair
for bladder and ureteral injuries. Further prospective studies are needed to delineate
the ideal surgical approach for these injuries.